Breast and Cervical Cancers in Barbados A Situational Analysis HEATHER ARMSTRONG MEDICAL OFFICER OF HEALTH, MINISTRY OF HEALTH, BARBADOS

Breast and Cervical Cancers in Barbados A Situational Analysis HEATHER ARMSTRONG MEDICAL OFFICER OF HEALTH, MINISTRY OF HEALTH, BARBADOS

Contents Background Barbados Strategic Plan for the Prevention and Control of NCDs Behavioural risk factor in Barbadian females 25 years and older Cancer in Barbados Barbados Cancer program Challenges Opportunities

Background Population 287,400 (May 9, 2016)

Barbados Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2015-2019 Identifies priority action aligned with the Caribbean Cooperation In Health (CCH3) Provides the framework for planning and programme implementation Integrative disease management and patient education Patient education enhanced Screening and early detection enhanced (80% of at risk population screened by 2017) Priority cancers addressed Palliative care enhanced

Behavioural Risk Factors in Women 25 years and Older Risk Factor Females (%) Prevalence of: Current Tobacco smoking (%) Alcohol consumers (last 12 months) Fruit and vegetable intake in adults (% of persons who eat less than 5 servings of fruits and vegetables a day) 3.7 29.9 88.5 % Low Physical activity 67.2 Obesity in adults (>30kg/m 2 ) 43.4 Source: The Barbados Health of the Nation Study (HotN) core findings 2015-National crosssectional population based survey

Cancer in the Barbadian Female

CANCER MORTALITY PROFILE (2008) Source: Barbados Cancer Profile PAHO, 2013

Treatment for first cancers Source: Cancer in Barbados 2008: Annual report of the BNR-Cancer

Mean time to first treatment and proportion treated within 4 weeks Source: Cancer in Barbados 2008: Annual report of the BNR-Cancer

Five-year survival from cancer for patients diagnosed in 2008, for main sites (diagnosed in 85% of patients), Barbados (N=946) Source: Cancer in Barbados 2008: Annual report of the BNR-Cancer

Cancer Control Program

Cancer Prevention Program- Barbados Risk Reduction- National NCD Action plan to address Risk Factors- Tobacco smoking, Physical activity, Alcohol use and Diet HPV Vaccinations (2013) Prevention Screening and Early detection Cervix-Pap smear, HPV DNA test Breast-Clinical examination and mammograms Pre cancer treatment (Cervix)-Colposcopy, Cryotherapy, LEEP and Cold Knife Conization Treatment of invasive cancers Diagnosis ad Treatment Palliative Care Palliative services available in both private and public sector Strategic Management: Multidisciplinary approach to cancer prevention and partnerships- Strong advocacy and leadership role from civil society groups Surveillance: The Barbados National Registry (National Population Based Cancer Registry) Strong National Primary Health Care programmes Referral system between primary, secondary and tertiary care

Capacity for Cancer Control In Barbados National Cancer Plan Budget for the Cancer Program Monitoring and Evaluation In development Screening Services Cervical cytology Available in both the Clinical breast private and public Examination sector. Chemotherapy Radiotherapy Oral Morphine mammography No No Available Available Available Guidelines- standards to allow auditing of the quality of care Training- required at all levels Equipment- lack of access in the public sector Research-limited information technology and Heath information support

Gynaecological Cancer and Diagnostic Unit at the Queen Elizabeth Hospital (QEH). President of the Barbados Cancer Society Dr Dorothy Cooke-Johnson and Minister of Health John Boyce cutting the ribbon to open the Gynaecological Cancer and Diagnostic Unit. - The unit serves as a referral, diagnostic and therapeutic centre for women diagnosed with gynaecological cancers, such as cervical, ovarian, uterine and endometrial, vaginal and vulvar. The centre offers PAP smears and colposcopy clinics for early detection and treatment of non-invasive cancers Allows for seamless referral for those individuals who require further interventions like surgery, chemotherapy and radiotherapy,

Challenges Loss of technical and financial support from international donors Reduced financial commitment from local government due to economic downturn Less than adequate technical and administrative support to enhance prevention and control activities Lack of integrated clinical management programme and systematic reporting Risk Reduction Factor: Continued perception by policy makers and the public that the priority in health revolves around tertiary care preventions Lifestyle component Treatment: Human resources-access and staffing ratio at QEH funding of second line drugs Training of junior staff needed to improve patient outcomes

Identifying Breast Cancer Screening Barriers among Barbadian women Fear of a breast cancer diagnosis Fear of the mammogram machine Fear of losing a romantic relationship as the result of a breast cancer diagnosis (women aged 40-49) Fear of being stigmatized A Report by Misha Granado and Angela Rose

Opportunities For Change-Way Forward All of Government response- all sectors working together to address the risk factors Increasing commitment of all stakeholders to communicate and advocate for issues pertaining to women cancers in the Caribbean Support from agencies such as Caribbean Public Health Agency (CARPHA) in the area of surveillance Strong alliance with Media to continue to bring awareness to the issues Willingness of the public to engage in issues pertaining to the adoption of healthy lifestyles Development and implementation of a national cancer plan

The End Thank You

Sources The Planning and Research Unit. Report of the Chief Medical Officer of Health 2007-2009. Ministry of Health, Barbados. December 2013 National NCD Commission Barbados, Ministry of health. Barbados Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2015-2019. December 2014 Unwin N, Rose AMC, George KS, Hambleton IR, Howitt C. The Barbados Health of The Nation Survey: Core Findings. Chronic Disease Centre, The University of the West Indies and Barbados Ministry of Health, Barbados, January 2015 Pan American Health Organization. Barbados Cancer Profile 2013. Rose AMC, Martelly TN, Craig L, Campbell J, Hambleton I, Prussia P. Cancer in Barbados 2008: Annual report of the BNR-Cancer. Chronic Disease Research Centre, The University of the West Indies, St Michael, Barbados Martin D, Luciani S, Prieto E, Hutton M and Kanda T. Situational Analysis Of Cervical Cancer Prevention And Control In The Caribbean. Pan American Health Organization December 2013 Granado M and Rose AMC. Identifying Breast Cancer Screening Barriers among Barbadian women. Chronic Disease Centre, The University of the West Indies